Becoming an X-Ray Tech

Coming Soon... a new resource for those interested in pursuing a career as a Radiologic Technologist.  

UPDATE:  For more information on the updated title, "Becoming a Radiologic Technologist", visit my link on Amazon.com (Prime members may borrow this book for free)

10 "Do's" and 10 "Don'ts" When it's Slow

When staff techs and students aren't performing their primary function of taking x-rays, they sometimes struggle coming up with ideas of things to do to remain productive.  You might be at a clinical site that rarely slows down long enough for you to get in trouble, but sooner or later, you will run into one of those low-volume days.  I'm not trying to say that you shouldn't take an opportunity to relax once in a while, but sooner or later, something will need to be accomplished with all the people standing around or people will probably be sent home.

What you decide to do with this time could make a big difference when it comes time to offer a student a job, or during annual evaluations as a technologist.  Here are 10 things that you can do in these moments:

1. Clean and disinfect rooms, wipe down x-ray equipment, portables and c-arms
2. Stock linens and supplies (this will help you get used to where the supplies are located)
3. Organize equipment and supplies to look presentable
4. Check supplies and medications/contrast media for expiration dates and purge expired items
5. Check the crash carts and blanket warmers 
6. Look for depleted oxygen tanks in the department and replace
7. Clean image plates if you have CR systems (have a tech show you how if you haven't done it before)
8. Make sure each room has oxygen and suction supplies ready to use
9. Make copies of any forms that are running low and check to see if printers need paper
10. Review images for quality control and practice critique

To contrast, here are 10 things that you should try to avoid when it's slow.  Don't:

1. Sit down and kick your feet up (and expect a break in 20 minutes)
2. Make a personal phone call in the department
3. Disappear without saying anything - let someone know if you need to step out
4. Engage in gossip
5. Complain about being slow
6. Have sensitive/personal conversations in common areas
7. Play video games on your smart phone or browse social media
8. Bring food into the patient care area
9. Barge into a room with an exam underway - even if you're just trying to help
10. Put KY jelly in another tech's 7-layer burrito and expect them to laugh (true story - wasn't me)

When you're not completely busy, it doesn't necessarily mean the work is finished.  I like to think down time can be somewhat of a reward for working so hard most of the time.  It's up to you to determine where to draw the line between a good reprieve between busy moments, and taking advantage of the situation.  During these moments, try to think about how an Instructor, Manager, or Director would perceive your actions and whether or not you could justify the actions they observe.

Radiograph of the Week

What's the diagnosis?
Explain in the comments:
 

Radiology Myth-Busters: CR Myths #5

This CR system only responds to certain kVp ranges:  FALSE

We know that digital imaging systems no longer utilize the traditional H&D curve, but instead have a wider “Dynamic Range” of exposures that can be considered useful for the final image. 

For this reason, processing algorithm (See post #2 in this series) has greater impact on image contrast than kVp selection

With CR systems, kVp does not have the same impact as with film/screen imaging.  We know that the fundamentals of x-ray interaction with matter remain constant, but as we have always known, even with film/screen imaging, is that the interaction of the phosphor material will vary based on composition and kVp range.  Consider the variation in k-edge absorption values.  The k-shell electron binding energies of the phosphors that are used in traditional film/screen imaging, as well as the BaSrSO4 in the CR phosphor plate are compared below:

Y2O2S:Tb      = 17 keV

BaFBr:Eu or BaFI:Eu     = 37 keV

LaOBr:Tm       = 38 keV

Gd2O2S:Tb      = 50 keV

CaWO4       = 69 keV

In order to produce the most efficient beam, the average energy of the beam should be enough to free the k-shell electron from its orbit using one of these phosphor compounds.  You could say that yttrium has an “edge” over the rest because it has the lowest binding energy of all the compounds… but is it going to be the most efficient for the diagnostic range that we need for plain radiography.  The PSP compound is extremely low, meaning that you can have just as much screen efficiency at lower kVp values compared to most of the other screens.  Anything above that range should not affect efficiency when comparing one screen to another, so the CR image plates should not be considered to require different kVp ranges, and certainly not one specific kVp range for that particular screen.

This doesn’t mean that we CAN’T use certain kVp ranges, it just means that there is an optimum efficiency that we should be taking advantage of.  It also means that we have the capability with CR imaging to use higher kVp ranges.  If the processing algorithm is primarily responsible for image contrast, there is a great bit of latitude with the range of kVp that we can use... as long as we maintain the appropriate exposure to the image receptor.  The added benefits of that include more uniform part penetration with better visualization of anatomy (see Reducing Radiation Dose in Diagnostic Radiography), and that we can reduce the amount of mAs required at higher kVp ranges, thus extremely lowering patient dose.  These can be accomplished without affecting image contrast to the degree in which it would be affected with film/screen systems.

The main take away with all of this should be that what the CR system needs in order to perform its job as designed is exposure to the plate.  We still control that as the Technologist, and we still have to be educated properly to determine what the BEST method of exposure should be taking all things into account; patient dose, image quality, and variations with each patient and all of the different types of equipment we are using.  It is far more important to have the proper beam/part/film alignment, along with exposure factors that produce the least exposure necessary for the highest image quality when using CR imaging systems.

I hope you have enjoyed this series on Myths about CR Imaging... here are the other posts in the series:

Myth #1:  An Increase in Exposure Creates an Increase in Density

Myth #2:  Radiographic Image Contrast is Controlled Only by kVp

Myth #3:  Room Light will Fog the Phosphor Plate

Myth #4: You Don't Really Need to Collimate with CR - You Can Simply Crop Your Images

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Radiology Myth-Busters: CR Myths #4

You don't really need to collimate with CR... you can simply crop your images.

Unfortunately, this is a practice seen all too often.  Most Technologists will not admit to it, but I know it happens.  Just ask any Radiography Student.  There are several reasons this is a poor habit to get into.

Radiation Protection - it should be a priority of every Technologist to maintain radiation dose ALARA.  If you are knowingly including anatomy within your field that is not necessary for the sake of the exam you are performing, it is unethical to expose your patients in this manner.  Pure laziness!

Reduction in image quality - the same basic principles of radiation physics apply during image production whether you are talking about film/screen, CR or DR imaging.  If you are exposing a larger area of tissue than you need to for the body part you are imaging, you will be creating unnecessary scatter radiation.  Knowing that digital systems are more sensitive to scatter and background radiation should influence the Technologist to be even more conservative on the collimation, and not the other way around.  It's true that the image can be adjusted post-processing to make changes to image contrast, but not recommended.  The raw data from the initial exposure will contain information from scatter radiation that degrades image quality even if you manipulate it later... garbage in, garbage out.

Increased risk of processing errors - we know that the initial data will be evaluated by the software to find the "values of interest" for each radiographic exposure.  The idea is that the anatomical regions that you are attempting to obtain a diagnostic image of should be manipulated during the initial processing algorithm to be displayed to appear appropriately at the display after processing - the best way to accomplish this is to use the correct exposure factors and collimate.  The more data included in your initial data set that does not need to be included in the image, the greater the risk that the "values of interest" will not be properly detected (see "Anatomy of a Histogram" for more detail).  If a large number of dark (exposed) pixels are included in the VOI by mistake, the software assumes that there is an overexposure due to the average pixel value being on the darker side.  Performing its function, the software will make the entire image display lighter than desired.

Legal concerns - I have not been able to reference any legal cases in which cropping anatomy that was recorded has ever caused a patient harm, but that doesn't mean the potential for such a situation does not exist.  We will be required to report dose information in the near future for all exams.  It's already starting with CT, and general radiology will be soon to follow.  If the total dose administered for every type of exam that you perform is 30% greater compared to another technologist, you can see how your employer may consider you to be a liability.  

I'm not sure that it's appropriate to say that this post is about a myth, but it does seem like a general assumption that many Technologists make.  Perhaps we all need to be reminded that just because technology exists that help with sloppy practices, it doesn't mean we should become complacent about our imaging techniques... and I'm off my soap box.

Other posts in this series:

Myth #1: An increase in exposure creates an increase in density

Myth #2: Radiographic image contrast is controlled only by kVp

Myth #3: Room light will fog the phosphor plate

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Radiograph of the Week "Fish-hooked"

Radiology Myth-Busters: CR Myths #3

Room light will fog the phosphor plate:  FALSE

By now, I'm sure that we have all used a CR cassette that has worn-out latches and springs.  Due to the way some manufacturers construct their photostimulable phosphor plates, they can slide right out of the cassette and onto the floor, leaving the device holding the latent image susceptible to room light and/or dirt and scratches.  You pick up the PSP from the floor, and what do you do?

Let me reassure you by saying that your image will not be fogged at all like it would have been with film/screen.  In fact, a mistake like that with film/screen would completely ruin your image no questions asked; no need to run it through the processor to check... it would go straight to the repeat bin.  You can freely process it without fear of image fog, although you're going to want to clean your screen before re-inserting it into the cassette.

So why isn't the PSP affected by room light?  When compared to film/screen, the plate does not respond to the lower frequency of room light like film does.  In fact, in order to see any radiographic density at all, the plate has to be ionized, which releases electrons from the valence band and sends them to the electron traps within the PSP (click here for more information on how the CR Image Plate works).  Room light is simply not going to cause ionization of the plate.

I can hear what you are thinking already... "but why is it called 'photo' stimulable if it doesn't respond to light?"  When a high frequency light source, like that of a laser seen in the previously mentioned post, this frees the electron traps of their charge and in turn, releases energy - some of it in the form of light.  But this has the opposite effect of fog... here's how the relationships mesh together:

The higher the x-radiation exposure to the plate, the more electrons are released from the valence band and collected into the electron traps.  The more electrons collected in the trap, the higher signal received during processing for that particular region of the image.  The higher signal received, the greater the density displayed (darker pixel values). 

The release of the electrons from the image plate by the laser scanner will actually reduce the amount of charge collected in the trap, therefore reducing density.  If you read the whole post I referred to above, there is a very cool lab experiment that can be performed to display this concept with a laser-pen for the instructors out there that are reading this.

So a few minutes of exposure to room light will not fog your radiograph, and exposure to high-intensity laser or fluorescent light will actually decrease density on your final image.  The most common ways you will see fog on your image receptor is if you have your image plate in the x-ray room during an exposure, leaving it exposed to scatter radiation (click here to learn about CR Image Plate Response to Scatter), or if you neglect to erase your image plates over long periods of not being used - most manufacturers recommend erasing the plates daily, or at least every 48 hours.

Additional posts in this series:

CR Myths #1 - An Increase in Exposure Creates an Increase in Density
CR Myths #2 - Radiographic Image Contrast is Controlled by kVp